The role of high-dose chemotherapy in the management of germ cell tumors Journal Article


Authors: Bastos, D. A.; Feldman, D. R.
Article Title: The role of high-dose chemotherapy in the management of germ cell tumors
Abstract: PURPOSE OF REVIEW: To discuss the current role and future perspectives of high-dose chemotherapy (HDCT) in the management of advanced germ cell tumors (GCTs). RECENT FINDINGS: Multiple studies have demonstrated the safety and efficacy of HDCT, consisting of carboplatin and etoposide followed by stem cell reinfusion, for the salvage treatment of GCTs. However, three randomized trials showed no benefit for HDCT over conventional dose chemotherapy in the first-line setting. Similarly, adding a third drug to etoposide with carboplatin does not seem to substantially improve treatment efficacy and may increase toxicity and mortality. Recent retrospective data from single centers and a large international collaboration demonstrated better outcomes with use of HDCT in the initial (rather than later) salvage setting as well as with sequential rather than single cycle regimens. However, randomized data are lacking. Prognostic factors for outcome to salvage HDCT were recently established and enhanced supportive measures such as growth factors and antibiotic prophylaxis have resulted in a dramatic decrease in morbidity and mortality. SUMMARY: HDCT plays an integral role in the salvage treatment of patients with advanced GCTs. However, optimal timing (initial vs. later salvage), dosing, number of high-dose cycles, and patient selection remain to be defined. © 2014 Wolters Kluwer Health.
Keywords: cancer survival; event free survival; overall survival; review; cancer recurrence; bevacizumab; cisplatin; area under the curve; cancer combination chemotherapy; patient selection; gemcitabine; paclitaxel; drug megadose; neurotoxicity; antineoplastic agent; cancer incidence; carboplatin; progression free survival; multiple cycle treatment; nephrotoxicity; thrombocyte; bone marrow suppression; etoposide; cyclophosphamide; autologous stem cell transplantation; kidney failure; antineoplastic activity; chemosensitivity; retrospective study; ifosfamide; thiotepa; vinblastine; health care quality; cancer regression; statistical analysis; neutrophil; comorbidity; stem cell mobilization; bleomycin; testicular cancer; germ cell tumor; germ cell tumors; hematologic disease; randomized controlled trial (topic); phase 2 clinical trial (topic); phase 1 clinical trial (topic); bone marrow metastasis; high-dose chemotherapy; failure free survival; cancer prognosis; human; priority journal
Journal Title: Current Opinion in Oncology
Volume: 26
Issue: 3
ISSN: 1040-8746
Publisher: Lippincott Williams & Wilkins  
Date Published: 2014-05-01
Start Page: 284
End Page: 293
Language: English
DOI: 10.1097/cco.0000000000000070
PROVIDER: scopus
PUBMED: 24670607
DOI/URL:
Notes: Curr. Opin. Oncol. -- Export Date: 2 June 2014 -- CODEN: CUOOE -- Source: Scopus
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  1. Darren Richard Feldman
    276 Feldman